Apply to YouShine Club Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstMiddleLastEmail *Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeGender *FemaleMaleAge *Ethnicity *American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteHeight: feet *inches *Weight (in lbs) *Marriage & ChildrenMarital Status *Single / Never MarriedDivorcedWidowedNumber of Past Marriages *123+Number of Children *Do You Want Any Children? *NoYesCareer, Politic View, & ReligionProfession *Education Level *Master's degree or higherBachelor's degreeSome collegeHigh schoolOthersIncome$100,001 +$70,001 - $100,000$45,001 - $70,000$25,001 - $45,000< $25,000Religion *ChristianityJudaismIslamBuddhismHinduismAtheistsAgnosticsOthersPolitical View *RepublicanDemocratIndependentSomething elseHabits & HobbiesDo you drink? *NoSociallyRegularlyHeavilyDo you smoke? *NoSociallyRegularlyHeavilyDo you do drugs? *NoSociallyRegularlyHeavilyDo you have/want pets?NoYesWhat kind of pets? *DogsCatsFishOthersPlease specify *Hobbies *Dating & RelationshipHow long is the longest relationship you have been in? *Under 1 yearOver 1 yearOver 5 yearsOver 10 yearsWhen it comes to dating, what best describes your interest? *I want to date but nothing seriousI want a relationshipI am putting a serious effort to find someoneI am serious and I want to find someone to marryDescribe Your Perfect Match *Your Match's Age: Min *Max *How Would You Describe Yourself *ReferencesPlease provide 2 references. We will contact them by phone as part of the club member evaluation process.Name *FirstLastPhone *EmailReference #2 *FirstLastPhone *EmailDocuments (max file sizes 2MB)Current Photo * Click or drag a file to this area to upload. A photo appropriate to show a child is appreciated.ID (Drivers License, Green Card, Passport, etc) *I have emailed a copy of my ID to singles@liferenewingcenter.orgFor all club members' safety, we require a copy of your identity document. For your safety, we are collecting the document via email.Terms & ConditionBy clicking submit, I agree to the following requirements. *I read and agree to the following requirements *1. You must have strong moral values, be honest, polite, and compassionate, and you are free of substance abuse or anger-management problems. 2. Fill out the YouShineClub application form truthfully. False information is strictly prohibited. 3. Provide a copy of US drivers license, green-card or other ID such as a passport. 4. Provide recommendations from at least two friends or family members who can confirm that you are single. 5. Commit to online and in-person participation in most singles’ network events held by YouShineClub. 6. You must be 28 years or older. 7. If accepted to the program, you agree to pay $99 for the first year, and $2,999 annually thereafter if you choose to renew (i.e. we don't want you to stay XD).Submit